Effect of Radial Nerve Release on Lateral Epicondylitis Outcomes: A Prospective, Randomized, Double-Blinded Trial

      Purpose

      The purpose of our study was to examine the result of lateral epicondylitis surgery with and without posterior interosseous nerve release.

      Methods

      We conducted a prospective, randomized, double-blind single-center clinical trial in 54 patients treated surgically for lateral epicondylitis, without any EMG or imaging sign of compression of the posterior interosseous nerve at the arcade of Frohse. The patients were equally divided into intervention (supplemental radial nerve release) and control groups (no radial nerve release). Clinical symptoms and disability related to the upper extremity were assessed by a blinded assessor prior to surgery, using both the Quick Disabilities of the Arm, Shoulder, and hand (QuickDASH) and Mayo Elbow Performance Score (MEPS) and again at 1-, 3-, and 6-month intervals after surgery.

      Results

      Significant improvement was observed in both groups from the first month after surgery and for the whole evaluation period for both the MEPS and the QuickDASH scores.

      Conclusions

      Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement.

      Type of study/level of evidence

      Therapeutic I.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jebson P.J.
        • Engber W.D.
        Radial tunnel syndrome: long-term results of surgical decompression.
        J Hand Surg Am. 1997; 22: 889-896
        • Ritts G.D.
        • Wood M.B.
        • Linscheid R.L.
        Radial tunnel syndrome.
        Clin Orthop Relat Res. 1987; 219: 201-205
        • Sarhadi N.S.
        • Korday S.N.
        • Bainbridge L.C.
        Radial tunnel syndrome: diagnosis and management.
        J Hand Surg Br. 1998; 23: 617-619
        • Sotereanos D.G.
        • Varitimidis S.E.
        • Giannakopoulos P.N.
        • Westkaemper J.G.
        Results of surgical treatment for radial tunnel syndrome.
        J Hand Surg Am. 1999; 24: 566-570
        • Moradi A.
        • Ebrahimzadeh M.H.
        • Jupiter J.B.
        Radial tunnel syndrome, diagnostic and treatment dilemma.
        Arch Bone Joint Surg. 2015; 3: 156-162
        • Loh Y.C.
        • Lam W.L.
        • Stanley J.K.
        • Soames R.W.
        A new clinical test for radial tunnel syndrome—the Rule-of-Nine test: a cadaveric study.
        J Orthop Surg (Hong Kong). 2004; 12: 83-86
        • Dang A.C.
        • Rodner C.M.
        Unusual compression neuropathies of the forearm, part I: radial nerve.
        J Hand Surg Am. 2009; 34: 1906-1914
        • Lister G.D.
        • Belsole R.B.
        • Kleinert H.E.
        The radial tunnel syndrome.
        J Hand Surg Am. 1979; 4: 52-59
        • Rosenbaum R.
        Disputed radial tunnel syndrome.
        Muscle Nerve. 1999; 22: 960-967
        • Steichen J.B.
        • Christensen A.W.
        Posterior interosseous nerve compression syndrome.
        in: Gelberman R.H. Operative Nerve Repair and Reconstruction. JB Lippincott, Philadelphia1991: 1005-1022
        • Verhaar J.
        • Spaans F.
        Radial tunnel syndrome. An investigation of compression neuropathy as a possible cause.
        J Bone Joint Surg Am. 1991; 73: 539-544
        • Erak S.
        • Day R.
        • Wang A.
        The role of supinator in the pathogenesis of chronic lateral elbow pain: a biomechanical study.
        J Hand Surg Br. 2004; 29: 461-464
        • Spinner M.
        The arcade of Frohse and its relationship to posterior interosseous nerve paralysis.
        J Bone Joint Surg Br. 1968; 50: 809-812
        • Werner C.O.
        • Haeffner F.
        • Rosen I.
        Direct recording of local pressure in the radial tunnel during passive stretch and active contraction of the supinator muscle.
        Arch Orthop Trauma Surg. 1980; 96: 299-301
        • Polson K.
        • Reid D.
        • McNair P.J.
        • Larmer P.
        Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire.
        Man Ther. 2010; 15: 404-407
        • Gabel C.P.
        • Yelland M.
        • Melloh M.
        • Burkett B.
        A modified QuickDASH-9 provides a valid outcome instrument for upper limb function.
        BMC Musculoskelet Disord. 2009; 10: 161
        • World Medical Association
        World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.
        JAMA. 2013; 310: 2191-2194
        • Rayan G.M.
        • Coray S.A.
        V-Y slide of the common extensor origin for lateral elbow tendonopathy.
        J Hand Surg Am. 2001; 26: 1138-1145
        • Dawson J.
        • Fitzpatrick R.
        • Carr A.
        • Murray D.
        Questionnaire on the perceptions of patients about total hip replacement.
        J Bone Joint Surg Br. 1996; 78: 185-190
        • Cusick M.C.
        • Bonnaig N.S.
        Accuracy and reliability of the Mayo Elbow Performance Score.
        J Hand Surg Am. 2014; 39: 1146-1150
        • Baker Jr., C.L.
        • Murphy K.P.
        • Gottlob C.A.
        • Curd D.T.
        Arthroscopic classification and treatment of lateral epicondylitis: two-year clinical results.
        J Shoulder Elbow Surg. 2000; 9: 475-582
        • Nirschl R.P.
        • Pettrone F.A.
        Tennis elbow. The surgical treatment of lateral epicondylitis.
        J Bone Joint Surg Am. 1979; 61: 832-839
        • Pannier S.
        • Masquelet A.C.
        Treatment of epicondylitis by deep fasciotomy of the extensor carpi radialis brevis and supinator: a review of 18 cases [in French].
        Rev Chir Orthop Reparatrice Appar Mot. 2002; 88: 565-572
        • Roles N.C.
        • Maudsley R.
        Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment.
        J Bone Joint Surg Br. 1972; 54: 499-508
      1. Steichen JB, Mulbry LW, Christensen AW. Radial tunnel syndrome: clinical experience and results of treatment. Presented at: Society of Military Orthopaedic Surgeons; December 4-9, 1988; Williamsburg, VA.

        • Dzugan S.S.
        • Savoie III, F.H.
        • Field L.D.
        • O’Brien M.J.
        • You Z.
        Acute radial ulno-humeral ligament injury in patients with chronic lateral epicondylitis: an observational report.
        J Shoulder Elbow Surg. 2012; 21: 1651-1655
        • Garg R.
        • Adamson G.J.
        • Dawson P.A.
        • Shankwiler J.A.
        • Pink M.M.
        A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis.
        J Shoulder Elbow Surg. 2010; 19: 508-512
        • Kim J.W.
        • Chun C.H.
        • Shim D.M.
        • et al.
        Arthroscopic treatment of lateral epicondylitis: comparison of the outcome of ECRB release with and without decortication.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1178-1183
        • Raeissadat S.A.
        • Rayegani S.M.
        • Hassanabadi H.
        • Rahimi R.
        • Sedighipour L.
        • Rostami K.
        Is platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: one year randomized clinical trial.
        BMC Sports Sci Med Rehabil. 2014; 18: 12
        • Celik D.
        Psychometric properties of the Mayo Elbow Performance Score.
        Rheumatol Int. 2015; 35: 1015-1020

      Linked Article